The Role of Tranexamic Acid (TXA) in Military Trauma: Current Practices and Implications for the Future

Hugh W Finlayson

Traumatology (Tallahass Fla) 2018;0:2018.

Objectives: To review current literature on the use of Tranexamic acid in battlefield trauma to assess its effects on mortality and determine whether or not it should become more widely used in both civilian and military trauma.A subsection was to look at the feasibility of administering Tranexamic acid in a pre-hospital setting to minimise the time between injury and drug administration.

Methods: A search of the literature was performed on a variety of databases using the terms described in table 1. The papers were then reviewed and analysed regarding the effects of the drug in trauma.

Patients: The papers selected reviewed 21,160 patients as detailed in Table 2. These patients were across both military and civilian trauma units.

Outcomes: The main outcomes being examined were the effects on short term mortality at 24 and 48 hours and whether there was any increase in the thromboembolic risk associated with the administration of Tranexamic acid.

Results: The review of the literature showed that Tranexamic acid had a significant effect on improving mortality across the board (17.4% vs 23.9% mortality (p = 0.03)). This was most marked in the more severely injured who had received over 10 units of transfused blood (14.4% vs 28.4% mortality (p = 0.004)).In terms of side effects Tranexamic acid was shown to be safe in large doses, which is key for battlefield administration where there is a tendency to err on the side of overtreating. Interestingly, the risk of thromboembolic events was similar to those not receiving Tranexamic acid.

Conclusions: Tranexamic acid is a very safe and effective means of improving survival when used in combination with current practices involving the use of blood products and surgical interventions. Tranexamic acid can safely be administered in the pre-hospital setting to minimise the delay between injury and treatment. The use of Tranexamic acid should be incorporated into trauma management across the board in the both military and civilian cases particularly in the most severe cases.